Maxillofacial Surgery

Question 1

Signs and symptoms of maxillary fracture? (7)

Answer 1

pain, swelling, diplopia, assymetry, nose bleed,
altered sensation
mobility

Question 2

Classification of maxillary fractures?

Answer 2

Le Fort classification

1. horizontal
   - tooth bearing area detached
2. pyramidal
   - involves nasal bone and infraorbital rim
3. transverse
   - whole maxilla detached from base of skull
   involves FZ sutures.

Question 3

SI for maxillary fractures?

Answer 3

Occipitomental 15 and 30

Question 4

mgmt maxillary fractures?

Answer 4

monitor
pain relief
ORIF
closed reduction

Question 5

6 signs of a zygomatico-orbital fracture?

Answer 5

numbness of cheek
diplopia
assymetry
periorbital ecchymosis
subconjunctival haemorrhage
enopthalmus 
laceration
swelling, then flattening of zygoma
decrease in visual acuity
pain on eye movement

Question 6

rads for zygomatico-orbital fracture?

Answer 6

occipitomental 15 and 30

Question 7

tx zygomatico-orbital fracture?

Answer 7

conservative management and monitor
ORIF
closed reduction

Question 8

post op advice zygomatico-orbital fracture tx

Answer 8

avoid blowing nose
pain management
observe for retrobulbar haemorrhage

Question 9

signs and symptoms of mandibular fracture (8)

Answer 9

pain 
swelling
assymetry
occlusal derangement
limited opening
numbness
AOB
step deformity

Question 10

classification mandibular fractures

Answer 10

simple/compound/comminuted
no. of fractures
site of fracture
size of fracture
displaced/undisplaced
favourable/unfavourable

Question 11

investigations mandibular fracture

Answer 11

OPT and PA mandible rads

Question 12

mgmt mandibular fractures?

Answer 12

simple/undisplaced - monitor, analgesics

compound/ displaced - ORIF

Question 13

What is a cyst?

Answer 13

pathological cavity not filled with pus. can be filled with fluid, solid, semi-fluid

Question 14

3 types of cysts and examples of each?

Answer 14

inflammatory, developmental and non-odontogenic

inflammatory- radicular, residual, lateral, paradental

developmental - dentigerous, KCOT, eruption, gingival

non-odontogenic - nasolabial, nasopalatine

Question 15

Common treatments for cysts, pros and cons

Answer 15

enucleation- removal of whole lining, whole lining can be biopsied, allows primary healing BUT risks of: mandibular #, local damage, loss of tooth

marsupialisation- partial removal, when e is contraindicated. allows tooth eruption, easier BUT can close and reform, difficult after care, full cyst not examinable, slow healing, requires enucleation after

Question 16

What is a KCOT
Origin of KCOT

Most problematic features of KCOT

Answer 16

keratocystic odontogenic tumour
Rest of Serres - from dental lamina

problematic::
recurrent- 40-60%
due to friable capsule & daughter cysts
later presentation as grows mesially-distally

Question 17

Histological features of KCOT

Answer 17

thin keratinised epithelium
corrugated surface 
thin friable lining
daughter cysts
flat basement membrane
basal cell palisading
parakeratosis

Question 18

Radiographic features of KCOT

Answer 18

well defined, multilocular radiolucency
extends from angle of mandible to the body and upwards into ramus
bony wall - well demarcated and corticated

Question 19

What condition are multiple KCOTs associated with

Answer 19

Gorlin- Goltz syndrome

Question 20

Where do radicular cysts arise from?

Answer 20

epithelial rests of malassez
- part of cells making up periodontal ligament
developed from Hertwigs epithelial root sheath (HERS)

aka periapical cysts

Question 21

How do radicular cysts appear histologically?

Answer 21

epithelial lined fluid filled cavity
non keratinised stratified squamous epithelium
rests of Malassez
connective tissue capsule w/ cholesterol clefts
hyaline/rushton bodies

Question 22

How do radicular cysts appear radiographically?

Answer 22

well defined, round, radiolucency at apex of non vital tooth.
unilocular
corticated
continuous with lamina dura

Question 23

Where do dentigerous cysts arise from?

dentigerous cysts most likely to be seen associated with:

Answer 23

Dental follicle at reduced enamel epithelium and crown

most likely seen in L8s and U3s

Question 24

How do dentigerous cysts appear histologically?

Answer 24

Thin, non-keratinised stratified squamous epithelium.
attachment to tooth at or close to adj
flat basement membrane
no inflammation

Question 25

How do dentigerous cysts appear radiographically?

Answer 25

unilocular, well circumscribed radiolucency
extending from ACJ of tooth
corticated margins
contains crown of unerupted tooth displaced from normal position

Question 26

name 1 epithelial derived tumour

Answer 26

ameloblastoma

benign
more common in mandible

Question 27

name 1 epithelial and mesenchyme derived tumour

Answer 27

odontoma

complex or compound
benign
most common odontogenic tumour

Question 28

name 1 mesenchyme tumour

Answer 28

odontogenic myxoma

intraosseous neoplasm, benign but locally aggressive

Question 29

indications for orthognathic surgery?

Answer 29

restore function and aesthetics

correct severe skeletal discrepancy

Question 30

Risks orthognathic surgery?

Answer 30

relapse
nerve damage
bleeding
infection
tmd
unrealistic pt expectations not met

Question 31

2 types of maxillary surgery

Answer 31

Le Fort 1

Anterior maxillary osteotomy

Question 32

2 types of mandibular surgery

Answer 32

BSSO bilateral saggital split osteotomy

VSSO vertical subsigmoid osteotomy